urolgy

Question 1

Drug treatment for UTI if the patients eGFR is less than 45ml/minute

Answer 1

TRIMETHOPRIM
- may also cause rise in creatinine

Question 2

52 Male: left sore testicle over past 2 weeks w/ unintentional weight loss over past 6 months

OE: left hemi-scrotum ‘bag of worms’ texture

Important next investigation to reveal underlying diagnosis:

Answer 2

USS ABDOMEN

why?
- left sided varicocele may be caused by obstruction of left renal or left testicular vein which drains into renal vain by INVASIVE RENAL TUMOUR

SO IF LHS varicocele –> image left kidney

Dilated veins in pampiniform plexus.

Question 3

This is a condition in which the foreskin occludes the meatus

Answer 3

Phimosis
–> painful intercourse
–> recurrent balanitis episodes

Question 4

Paraphimosis is:

Answer 4

• reduced venous return to glans leading to oedema and or ischaemia
• tight foreskin irreplaceable

Question 5

Management of renal stones

Answer 5

1. Analgesia (diclofenac)
2. watchful waiting <5mm ?
3. Stones <2cm
   –> EXTRACORPEAL SHOCKWAVE LITHOTRIPSY
   –> ureteroscopy (distal/middle stones or preggers)
4. Large complex stones (staghorn or cysteine stones)
   –> percutaneous nephrolithotomy
5. Nephrostomy: SIRS? SEPTIC? needing urgent decompression